Influence Of "Qishen Yiqi Droplet" On Inflammatory Reaction In Debakey Type Ⅲ Aortic Dissection Patients After Thoracic Endovascular Aneurysm Repair

ObjectiveTo investigate the effect of Qishen Yiqi dripping pills on blood serum c-reactive protein (CRP), Interleukin-6 (IL-6), Matrix metalloproteinase 9 (MMP-9), tumor necrosis factor a (TNF-α) levels in the patients with Debakey Type Ⅲ aortic dissection (AD) after thoracic endovascular aneurysm repair(TEVAR).Methods42 Debakey Type Ⅲ aortic dissection patients was admitted to Kanghua Hospital Cardiology in November 2013 to December 2014 and 30 of them after TEVAR were randomly assigned into two groups:the control group, n=15,with routine treatment, the test group,n=15, with Qishen Yiqi Droplet 5.0g three time a day combined with conventional therapy 2 mouths。The serum level of CRP, IL-6, MMP-9 and TNF-a was compared 24 hours before TEVAR,24 hours after TEVAR and 2 months after TEVAR in two groups respectively.While trends of inflammatory cytokines was observed over time.ResultsTwo groups of patients underwent TEVAR, preoperative levels of serum inflammatory factor CRP, IL-6, MMP-9 and TNF-a were comparable (P>0.05), the difference was not statistically significant; 24 hours after TEVAR, serum inflammation factor CRP, IL-6 and TNF-a in two groups significantly increased compared with preoperative (P<0.05), the difference was statistically significant; two months after TEVAR, serum CRP, IL-6 and TNF-a significantly declined compared with 24 hours after TEVAR, and basically dropped to normal (P<0.05), the difference was statistically significant, but for patients who had serious endoleak or poor long-term vascular remodeling after TEVAR, serum CRP of 2 month after TEVAR dropped compared with 24 hours after TEVAR, but not downed to the normal range; two months after TEVAR, serum CRP of experimental group decreased compared with the control group, but the difference was not statistically significant (P> 0.05); two months after TEVAR, serum IL-6 and TNF-a of the test group significantly decreased compared to the control group, the difference was statistically significant (P<0.05). serum MMP-9 were not significantly increased but declined in 24 hours after TEVAR in two groups compared with preoperative, the difference was not statistically significant (P>0.05); serum MMP-9 of two groups increased compared with preoperative, the difference was statistically significant (P <0.05); serum MMP-9 of the experimental group decreased slightly compared with the control group in 2 months after TEVAR, but the difference was not statistically significance (P>0.05).ConclusionsFirst, at the time of the onset of AD, serum IL-6, TNF-a and MMP-9 increased significantly, while the response of CRP was relatively slow and did not significantly increase. Serum inflammatory factors CRP, IL-6 and TNF-a increased rapidly after TEVAR, which have greater correlation with TEVAR surgery. MMP-9 slightly declined after TEVAR, but it increased 2 months after TEVAR again, so MMP-9 is a good prediction of chronic AD, but there is no significant correlation with TEVAR surgery.Second, For Debakey type III AD patients after TEVER, routine treatment combine with qishen Yiqi drop pills can lower the serum levels of inflammatory cytokines such as IL-6 and TNF-a. Chinese medicine qishan Yiqi Droplet lower serum inflammatory factors through the promotion of vascular endothelial cell repair, clearing free radicals so that aortic vascular remodel well, while Qishenyiqi Pills is of great significance for promoting the false lumen thrombosis.Third, for patients who had serious endoleak or poor long-term vascular remodeling after TEVAR, elevated serum CRP is a good predictor, and serum MMP-9 is a good predictor of long-term prognosis of chronic AD. So MMP-9 may combine CRP as a good predictor of long-term prognosis of chronic aortic dissection. Due to the smaller sample size of this study, it is necessary for further study through expanding the sample size.Fourth, Leukocytes and neutrophils rises at the time of the onset of AD due to the stress,. there is a downward trend after TEVAR, therefore, there is no significant correlation between Leukocytes and neutrophils and TEVAR.